Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon for Large to Massive Rotator Cuff Tears with Pseudoparalysis: A Prospective Clinical Study.

backgroundManaging large to massive rotator cuff tears accompanied by pseudoparalysis poses a considerable challenge in shoulder surgery. Superior capsular reconstruction (SCR) is increasingly considered a viable surgical option, yet optimal graft choices and outcomes in pseudoparalysis patients remain under investigation. This study assesses the clinical effectiveness of arthroscopic SCR using the long head of the biceps tendon (LHBT) in patients with large-to-massive RCT, comparing outcomes between those with and without pseudoparalysis.

methodsA prospective analysis was carried out involving 28 patients (14 with pseudoparalysis and 14 without) who underwent SCR using LHBT between January 2022 and December 2023. Clinical outcomes were assessed before surgery and subsequently at three, six and 12 months following the procedure, utilizing the Visual Analog Scale (VAS), University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion metrics.

resultsEach group demonstrated substantial gains in reducing pain, enhancing functional outcomes, and increasing shoulder mobility. VAS scores decreased markedly, and ASES and UCLA scores improved substantially in both groups. Forward elevation and external rotation improved significantly, with a slightly greater range observed in the non-pseudoparalysis group. Pseudoparalysis was successfully reversed in 92.85% of affected patients. No major complications were reported.

conclusionArthroscopic SCR using LHBT provides significant functional restoration and pain reduction in patients with massive RCT, effectively reversing pseudoparalysis in most cases. This technique offers a reliable and anatomically favorable graft option, supporting its use in both pseudoparalytic and non-pseudoparalytic patients.